Will this affect PEP? - Urgent and worried

May 20, 2011

Hi Doctor Bob,

I am three days into a course of PEP following an exposure - protected anal and oral intercourse with an HIV+ male - I was the receptive partner and there was a bit of bleeding on my part as the sex was rough and long - we changed condoms every 20 minutes or so and used lube - I'm not aware of any breakages although I only managed to retrieve three from the bin and test them - eeuugghh! (they were fine). He didnt ejaculate, doesnt produce any apparent pre-cum and is on treatment with an undetectable viral load and know knowledge of having any other STI's.

Anyway - over the first two days I had pretty bad diarhhoea around an hour or two after taking the meds - this has now died away but my question is - will the diarrhhoea affect the meds in any way? will they be poorly absorbed leading to PEP failure or will they still be effective?

I'm on Truvada and Kaletra - just taken my fifth dose and still within the 72 hours as I acted fast and started at 18 hours post exposure - I really should have acted faster.

Am I a high risk for HIV now? My partner assured me none of the condoms had any apparent defects or tears - he said if there was it would be noticeable but I dont know as Im so paranoid about the one I didnt get to check and the fact that the sex was rough.

My prescribing doctor told me it was a very high risk situation and prescribed me PEP - which my partner thought was a bit strange - he is a sex worker but seems to be well educated on HIV.

Response from Dr. Frascino

Hi,

I tend to agree with your sex worker buddy more than your doctor! If the latex condoms were used properly and didn't fail (break) and if Mr. Love-machine is indeed on effective combination antiretrovirals that have driven his HIV plasma viral load to undetectable levels, your HIV-acquisition risk wold be negligible and PEP would not be warranted. See link below.

Your problems with diarrhea for the first two days of your PEP course would not affect PEP efficiency or increase the risk of PEP failure.

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